How Drugs and Alcohol Can Cause Stroke

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Recreational Drugs, Alcohol, and Stroke

Drug use is a significant risk factor for stroke. But not all drugs have the same impact on stroke risk and different drugs affect the body differently.

Some drugs can cause stroke by directly harming blood vessels in the brain while others cause stroke indirectly, by impairing other organs in the body such as the heart, the kidneys or the liver. Common drugs of abuse that are known to increase the risk of strokes include the following:

Alcohol: Although alcohol in moderate amounts can protect you from having a stroke, there is no doubt that excessive intake can increase your risk of having a stroke. In fact, there is very specific information about how alcohol can cause a stroke and how much alcohol it takes to cause a stroke.

Chronic excessive alcohol intake can precipitate all types of stroke, and most notably sharply raises the risk of hemorrhagic stroke, which is a particularly dangerous type of stroke that causes bleeding in the brain.

The higher risk of stroke that results from excess alcohol intake appears to be due to a combination of high blood pressure and impaired blood clotting mechanisms.  One of the ways that alcohol interferes with blood clotting is by damaging the liver. The liver makes proteins which are necessary to prevent spontaneous bleeding. When the liver cannot adequately make these important proteins, excessive bleeding can result anywhere in the body, including the brain.

Cocaine: There is a clear association between cocaine use and stroke. Cocaine use can cause a sudden stroke during or shortly after using the drug. Additionally, long term repeated use of cocaine can also cause cerebrovascular disease over time, significantly increasing the risk of stroke, even in otherwise healthy young people who do not have any other risk factors of stroke.

The most important ways by which cocaine use increases the risk of stroke include the following:

  • By dramatically and quickly increasing blood pressure and causing bleeding in the brain
  • By causing sudden or gradual narrowing of blood vessels in the brain
  • If used in its intravenous form known as crack cocaine, it increases the risk of serious infections in the heart valves.This type of heart infection, called endocarditis, is among the many heart conditions that can lead to stroke.

Heroin: Heroin is an addictive drug that is commonly abused in the United States. Similar to intravenous cocaine, intravenous heroin also increases the risk of endocarditis, a condition in which bacteria enter the blood and grow over the valves of the heart. Small pellets of these bacteria, known as septic emboli, may leave the heart, head towards the brain and block a blood vessel in the brain, causing a stroke. Because heroin is injected, its use also increases the risk of diseases transmittable by the sharing of needles such as HIV and hepatitis C.

Heroin overdose can cause inadequate respiration, preventing enough oxygen from reaching the body. During a period of extremely low oxygen, a person can suffer from an irreversible stroke, even if he or she is revived and survives the overdose.

Amphetamines: There have been many reports documenting amphetamine use in the hours before a major stroke, even among young healthy individuals without stroke risk factors.

Amphetamines such as methamphetamine have a powerful ability to cause extreme levels of high blood pressure. As high blood pressure is the number one risk factor for stroke, it is not surprising that amphetamine use can increase a person's risk for stroke. As with cocaine, long term use of methamphetamine increases stroke risk by causing abnormal functioning in the blood vessels of the brain, while harming the rest of the body.

Short term use of methamphetamine may result in a sudden stroke during or after use, largely as a result of sudden changes in blood pressure and heart function induced by methamphetamine in the body.

Other drugs which have been linked to ischemic, hemorrhagic or hypertensive strokes include:

A systematic review of adverse events arising from the use of synthetic cannabinoids and their associated treatment, Tait RJ, Caldicott D, Mountain D, Hill SL, Lenton S, Clin Toxicol (Phila). 2016;54(1)


Edited by Heidi Moawad MD

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